| NPI | 1336657428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 4534) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 0010-07819) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2022-08-25 |